The devastating second wave of Covid-19 did not just show the serious gaps in India’s healthcare system, but also the weak legal protections patients have in accessing it. Without tangible rights such as non-discrimination in treatment or protection from overcharging, patients were left to fend for themselves during the worst health crisis in the history of independent India.
In August 2018, the Ministry of Health and Family Welfare released India’s first Patients’ Rights Charter with 13 patients’ rights incorporating the recommendations from National Human Rights Commission. In June 2019, one of the first actions of the Ministry of Health and Family Welfare after the government’s re-election was to issue a letter requesting state governments to adopt the charter.
Two years have passed since then, but no significant action was undertaken. The Union Government has constantly reiterated that charter and associated grievance redressal mechanisms are state subjects in Parliament. In July, recognising the lapse in the implementation of laws and regulations related to patients’ rights, a bench led by Chief Justice of India NV Ramana issued notice to the Union Government on the status of the implementation of the Patients’ Rights Charter.
However, no response has been filed to the same. In October, several media outlets reported Union government’s draft Right to Health and Health Care Bill, 2021, which does mention several patients’ rights and redressal mechanisms.
However, it continues to lack concrete provisions to address violations of patients’ rights due to skewed power dynamics with respect to class, caste, religion and gender between the healthcare providers and patients as Oxfam India study showed.
Extent of violations
Oxfam India’s latest report “Securing Rights of Patients in India: Lessons from rapid surveys on peoples” experiences of Patients’ Rights Charter and the Covid-19 vaccination drive’ shows the urgent need to enforce existing patients’ rights and develop robust grievance redressal mechanisms.
The nationwide survey showed over a third of women (35%) had to undergo a physical examination by a male practitioner without another female present in the room, a violation of patients’ rights. Similarly, a third of Muslim respondents and over 20% Dalit and Adivasi respondents reported feeling discriminated against on the grounds of their religion or caste in a hospital by a healthcare professional.
Twenty-two per cent of people belonging to the Scheduled Tribes and 21% belonging to the Scheduled Castes said that they have been discriminated against by healthcare providers or in a hospital setting due to their tribal identity/caste. Fifteen per cent of people belonging to the Other Backward Class said they felt discriminated against because of their caste.
In January, the Economic Survey of India acknowledged that high out-of-pocket expenditures on health are contributing to the high incidence of catastrophic expenditures and risking vulnerable groups slipping into poverty. “Private hospitals charge much higher than government hospitals for treatment of the same ailment and higher charges do not assure better quality,” the Economic Survey noted. Under regulated costs of medicines, diagnostics and hospitalisation contribute significantly to the out-of-pocket expenditures in India.
The survey showed that around eight in 10 respondents reported being asked to get tests/diagnostics from one place only. The practice is in violation of the patient’s rights to referral and transfer without perverse commercial influences. It leads to excessive expenditure by patients as they are denied the choice of a more affordable option.
The lack of transparency in bills and rate cards provided by private hospitals is another cause of increased expenses. In the Oxfam India survey, 58% of respondents were not provided with an estimated cost of treatment before the start of treatment and 31% were denied case papers and other documents even after requesting the same.
The pandemic also witnessed an overwhelming trend of private hospitals holding dead bodies “hostage” over non-payment of bills often violating court orders. The survey showed that this has disproportionately affected the poor. Nineteen per cent of respondents whose close relatives were hospitalised said that they were denied the release of the dead body by the hospital.
While this inhuman practice was experienced by people from all strata of the society, the heaviest brunt was borne by the poorest – 23% of those earning less than Rs 10,000 had faced the issue of denial of release of the dead body, unlike 15% of those earning more than Rs 1 lakh per month.
The drafting of the Right to Health and Healthcare Bill, 2021 is a welcome step. It is critical to ensure that the existing rules and regulations by the health ministry to protect patients are addressed. Without adequately addressing and providing recourse to citizens when their rights are violated, the new Bill risks failing to further universal healthcare in the country.
As Prime Minister Narendra Modi said at United Nations’ meet on Universal Health Coverage, “A healthy life is every person’s right. The onus for this is on our government to make every possible effort to ensure this.” Only through protecting the right of every citizen, rich and poor, men and women, can India ensure this.
Akshay Tarfe works with Oxfam India.